Enhancing later life: how older people perceive active ageing?

Modeling Age-Friendly Environment, Active Aging, and Social Connectedness in an Emerging Asian Economy

This paper empirically tested eight key features of WHO guidelines to age-friendly community by surveying 211 informal caregivers and 402 self-care adults (aged 45 to 85 and above) in Malaysia. We examined the associations of these eight features with active aging and social connectedness through exploratory and confirmatory factor analyses. A structural model with satisfactory goodness-of-fit indices (CMIN/df = 1.11, RMSEA = 0.02, NFI = 0.97, TLI = 1.00, CFI = 1.00, and GFI = 0.96) indicates that transportation and housing, community support and health services, and outdoor spaces and buildings are statistically significant in creating an age-friendly environment. We found a statistically significant positive relationship between an age-friendly environment and active aging. This relationship is mediated by social connectedness. The results indicate that built environments such as accessible public transportations and housing, affordable and accessible healthcare services, and elderly friendly outdoor spaces and buildings have to be put into place before social environment in building an age-friendly environment. Otherwise, the structural barriers would hinder social interactions for the aged. The removal of the environmental barriers and improved public transportation services provide short-term solutions to meet the varied and growing needs of the older population.

The personal active aging strategies of older adults in Europe: a systematic review of qualitative evidence

BACKGROUND

There is a consensus that the aging population is beginning to impact on many facets of our life. They have more medical problems and the potential to "drain" the focus of the medical community, as well as national budgets with their accompanying medical bills. Personal strategies related to active aging will help us to better understand and identify how older adults in Europe prepare themselves for the natural process of aging and what are their personal approaches to active aging.

OBJECTIVES

The objective of this review was to synthesize the best available evidence regarding the older adult's perspective on the personal strategies related to active aging among older adults in Europe.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

This review considered studies that included older adults (age over 55 years) who live in Europe.

PHENOMENA OF INTEREST

This review considered studies that investigated older adults' perspectives on (any) personal strategies related to active aging.

CONTEXT

Europe (considering "some similarity" in health care systems and retirement policies).

TYPES OF STUDIES

This review considered any qualitative designs.

SEARCH STRATEGY

A three-step search strategy was used to identify published and unpublished studies. The extensive search process was conducted in October 2014 and considered published and unpublished studies from the inception of databases until October 2014. Studies published in any language which had an abstract in English, Czech and Slovak languages were considered for inclusion in this review.

METHODOLOGICAL QUALITY

Studies were appraised for methodological quality by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI).

DATA EXTRACTION

Data were extracted from the papers included in the review by two independent reviewers using the standardized JBI-QARI data extraction tool.

DATA SYNTHESIS

Data synthesis was performed using the meta-aggregation approach of meta-synthesis recommended by the Joanna Briggs Institute.

RESULTS

Fourteen studies were included in this systematic review. From these 14 studies, 42 findings were extracted; findings were synthesized into four categories: (1) positive approach to life, (2) mental, social and physical activities, (3) adaptation, and (4) financial independence. Categories were synthesized into two synthesized findings: (1) if older adults adapt to changing situations and choose a positive attitude, they can find an active way to live and also a mission and meaning in their lives, (2) if older adults learn new activities, participate in exercise, keep balanced relationships and manage their financial resources, they will stay mentally, socially and physically active, and also financially responsible.

CONCLUSIONS

If older Europeans learn new activities, participate in exercise, keep balanced relationships and manage their financial resources, they will stay mentally, socially and physically active, and also financially responsible.

Perspectives of People with Dementia About Meaningful Activities: A Synthesis

Qualitative studies were synthesized to describe perspectives of people with dementia regarding meaningful activities. Themes of connectedness were identified using a meta-ethnography approach. The theme of being connected with self encompasses engagement for continuity, health promotion, and personal time. The theme of being connected with others includes being with others not to feel alone, doing an activity with others, and meaningful relationships. The theme of being connected with the environment encompasses being connected to one’s familiar environment, community, and nature. This synthesis suggests that connectedness is an important motivation for engagement in daily activities. Findings indicate that identifying the underlying motivation for an individual with dementia to engage in different activities is important for matching a person with activities that will be satisfying. This review may inform the development of interventions for engaging people with dementia in meaningful, daily activities and creating connectedness to self, others, and the environment.

Promoting change in meat consumption among the elderly: Factual and prefactual framing of health and well-being

Messages aimed at changing eating habits of the elderly are often not persuasive. In two studies, we tested the hypothesis that the persuasiveness of messages regarding the effects of meat consumption on health versus well-being would depend on their factual versus prefactual ('if … then … ') framing. Different groups of elderly participants were presented with different versions of a message describing the possible negative effects of excessive meat consumption. Results of a preliminary study showed that messages about the effects of meat consumption on health and well-being induced a different regulatory concern in recipients, safety and growth concerns respectively. Results of the two main studies then showed that messages about health/safety had stronger effects on participants' involvement, attitudes, and intentions to change eating behaviour when framed in factual rather than prefactual terms. Conversely, messages about well-being/growth had stronger effects when framed in prefactual rather than factual terms. Discussion focuses on how the appropriate framing of messages about meat consumption can effectively promote changes in eating habits of elderly people.

Active ageing and quality of life: factors associated with participation in leisure activities among institutionalized older adults, with and without dementia

OBJECTIVES

Active ageing, considered from the perspective of participation in leisure activities, promotes life satisfaction and personal well-being. The aims of this work are to define and explain leisure activity profiles among institutionalized older adults, considering their sociodemographic characteristics and objective and subjective conditions in relation to their quality of life.

METHODS

Two samples of institutionalized people aged 60 and over were analysed together: 234 older adults without dementia and 525 with dementia. Sociodemographic, economic, family and social network, and health and functioning variables were selected. Cluster analysis was applied to obtain activity profiles according to the leisure activities, and ordinal regression models were performed to analyse factors associated to activity level.

RESULTS

The sample was clustered into three groups of people: active (27%), moderately active (35%) and inactive people (38%). In the final regression model (Nagelkerke pseudo R(2) = 0.500), a higher level of activity was associated with better cognitive function (Pfeiffer scale), self-perceived health status and functional ability, as well as with a higher frequency of gathering with family and friends, and higher educational level.

CONCLUSION

The decline in physical and mental health, the loss of functional capabilities and the weakening of family and social ties represent a significant barrier to active ageing in a context of institutionalization.

Active Aging: Exploration into Self-Ratings of "Being Active," Out-of-Home Physical Activity, and Participation among Older Australian Adults Living in Four Different Settings

We examined whether self-ratings of "being active" among older people living in four different settings (major city high and lower density suburbs, a regional city, and a rural area) were associated with out-of-home participation and outdoor physical activity. A mixed-methods approach (survey, travel diary, and GPS tracking over a one-week period) was used to gather data from 48 individuals aged over 55 years. Self-ratings of "being active" were found to be positively correlated with the number of days older people spent time away from home but unrelated to time traveled by active means (walking and biking). No significant differences in active travel were found between the four study locations, despite differences in their respective built environments. The findings suggest that additional strategies to the creation of "age-friendly" environments are needed if older people are to increase their levels of outdoor physical activity. "Active aging" promotion campaigns may need to explicitly identify the benefits of walking outdoors to ambulatory older people as a means of maintaining their overall health, functional ability, and participation within society in the long-term and also encourage the development of community-based programs in order to facilitate regular walking for this group.

Modeling Active Aging and Explicit Memory: An Empirical Study

The rapid growth of the population of older adults and their concomitant psychological status and health needs have captured the attention of researchers and health professionals. To help fill the void of literature available to social workers interested in mental health promotion and aging, the authors provide a model for active aging that uses psychosocial variables. Structural equation modeling was used to examine the relationships among the latent variables of the state of explicit memory, the perception of social resources, depression, and the perception of quality of life in a sample of 184 older adults. The results suggest that explicit memory is not a direct indicator of the perception of quality of life, but it could be considered an indirect indicator as it is positively correlated with perception of social resources and negatively correlated with depression. These last two variables influenced the perception of quality of life directly, the former positively and the latter negatively. The main outcome suggests that the perception of social support improves explicit memory and quality of life and reduces depression in active older adults. The findings also suggest that gerontological professionals should design memory training programs, improve available social resources, and offer environments with opportunities to exercise memory.

Who are the healthy active seniors? A cluster analysis

BACKGROUND

This paper reports a cluster analysis of a sample recruited from a randomized controlled trial that explored the effect of using a life story work approach to improve the psychological outcomes of older people in the community.

METHODS

238 subjects from community centers were included in this analysis. After statistical testing, 169 seniors were assigned to the active ageing (AG) cluster and 69 to the inactive ageing (IG) cluster.

RESULTS

Those in the AG were younger and healthier, with fewer chronic diseases and fewer depressive symptoms than those in the IG. They were more satisfied with their lives, and had higher self-esteem. They met with their family members more frequently, they engaged in more leisure activities and were more likely to have the ability to move freely.

CONCLUSION

In summary, active ageing was observed in people with better health and functional performance. Our results echoed the limited findings reported in the literature.

Improving retirement outcomes: the role of resources, pre-retirement planning and transition characteristics

Retirement is an inherently complex process due to the multitude of variables that influence it. The present article proposes that by combining our understanding of retirement phases (a conceptual framework) with a theory that specifies a general mechanism for retirement adaptation (a theoretical framework), we can improve how we research retirement. Accordingly, this study proposes and tests a model exploring the antecedents and consequences of the retirement process across three stages: Pre-retirement, Transition and Adaptation, using data collected from 550 Australian retirees. Multiple outcomes are explored, including adjustment, wellbeing and life satisfaction, as well as variables including planning, perception of wealth, resources and mastery. The model showed a significant influence of resources on both phases and outcomes, with mastery showing the strongest relationships of all the resources. Results suggest that outcomes in retirement may be improved by promoting retirement planning, improving exit conditions and building key resources, in particular, mastery. Overall, the model demonstrates the value of combining theory and conceptual frameworks to inform the specification of statistical models to research retirement. Research implications and alternative models are discussed.

Development and psychometric testing of the active aging scale for Thai adults

Background

Active aging is central to enhancing the quality of life for older adults, but its conceptualization is not often made explicit for Asian elderly people. Little is known about active aging in older Thai adults, and there has been no development of scales to measure the expression of active aging attributes.

Purpose

The aim of this study was to develop a culturally relevant composite scale of active aging for Thai adults (AAS-Thai) and to evaluate its reliability and validity.

Methods

Eight steps of scale development were followed: 1) using focus groups and in-depth interviews, 2) gathering input from existing studies, 3) developing preliminary quantitative measures, 4) reviewing for content validity by an expert panel, 5) conducting cognitive interviews, 6) pilot testing, 7) performing a nationwide survey, and 8) testing psychometric properties. In a nationwide survey, 500 subjects were randomly recruited using a stratified sampling technique. Statistical analyses included exploratory factor analysis, item analysis, and measures of internal consistency, concurrent validity, and test–retest reliability.

Results

Principal component factor analysis with varimax rotation resulted in a final 36-item scale consisting of seven factors of active aging: 1) being self-reliant, 2) being actively engaged with society, 3) developing spiritual wisdom, 4) building up financial security, 5) maintaining a healthy lifestyle, 6) engaging in active learning, and 7) strengthening family ties to ensure care in later life. These factors explained 69% of the total variance. Cronbach’s alpha coefficient for the overall AAS-Thai was 0.95 and varied between 0.81 and 0.91 for the seven subscales. Concurrent validity and test–retest reliability were confirmed.

Conclusion

The AAS-Thai demonstrated acceptable overall validity and reliability for measuring the multidimensional attributes of active aging in a Thai context. This newly developed instrument is ready for use as a screening tool to assess active aging levels among older Thai adults in both community and clinical practice settings.

What it's like to grow older: the aging perceptions of people with an intellectual disability in Ireland

The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing is a national longitudinal study on the aging of people with an intellectual disability (ID) using a randomly selected sample of people with ID over the age of 40. In total, 367 people with an ID completed the aging perception self-report only section. Over 57% of people described their health as very good to excellent with no significant difference in health perceptions found for gender, level of ID, or living circumstance. Exploring people's perceptions utilizing PASW Text Analytics for Surveys 4.1 perceptions often supported negative views of the consequences of aging. These findings suggest challenging negative aging concepts is essential to promote positivity with associated improved health and wellbeing.

Prescribing mobility scooters in Australia: Occupational therapists' narratives

BACKGROUND/AIM

In order for older people to remain active and engaged as they age they need to be mobile in the community. One way of maintaining community mobility is through the use of a mobility scooter. Occupational therapists are key health professionals involved with assessing for mobility scooters yet minimal research exists into the experience. This study sought to explore occupational therapists' experiences of assessing for mobility scooters to older people in Australia.

METHODS

A qualitative study was undertaken in which narratives were solicited from 18 occupational therapists involved in scooter assessment to people aged 65 or over. Interview data were analysed following narrative analysis guidelines.

RESULTS

Analysis revealed six predominant narratives ranging from two success stories to the narrative of disempowerment and stories of negotiating risk. Experienced therapists had more resources and skills to draw on to manage the complexity of prescription and negotiation of risk.

CONCLUSIONS

Findings from this study suggest that novices or those new to mobility scooter prescription need to access supervision and support to improve the chances of having a successful outcome. Further exploration of how therapists manage situations of vulnerability and risk is warranted to prevent burnout for therapists and reduce the likelihood of restricting clients' occupational potential. Continuing professional development activities are also recommended.

Capacity building with older people through local authority and third-sector partnerships

In May 2010 a Conservative and Liberal Democrat Coalition Government was elected in the United Kingdom, which immediately started to plan a programme of wide-ranging cuts in public spending. However, in the face of severe economic problems the new government retained the outgoing government's emphasis on active ageing. This paper examines capacity-building partnerships between local authorities and third-sector organisations in LinkAge Plus (LAP) pilot areas in England, which were set up to find better ways to meet the needs of older people and empower them to become active citizens. The study on which this paper reports used theory on partnerships and collaboration to interrogate LAP pilot evaluation reports, along with current thinking on capacity building and work designed to improve services and outcomes for older people. The main findings are that capacity building in partnerships stimulated joined up working, which resulted in improved knowledge and skills in providing existing services. At the same time, new services emerged that meant older people were more involved in networking activities and social capital was created through their engagement in policy making, identifying needs, service design and finding solutions to problems. However, there were few instances of ideological activity that challenged established values and ways of working to go beyond traditional health and social care approaches in the delivery of services for older people. The potential impact of ongoing cuts in public spending are also considered.

Occupational engagement among community dwelling older people: A time-geographic perspective†

How older people spend their time in different occupations could contribute to our understanding of everyday life in healthy ageing. This study adopted a time-geographic method and occupational perspective to explore the occupational engagement of community dwelling older people. The term occupational engagement encompasses what people do, where and with whom they spend their time and the perceived level of competence and meaningfulness of their time use. Nineteen volunteers born between 1932 and 1933, living alone in an urban area in northern Sweden and receiving no home care services, completed open time-geographic diaries for 5 days in May 2010. The diary data were analyzed using Daily Life software program. The study revealed the complexity and the diversity of the older people's occupational engagement and that most of their time was spent alone in their home. The older people reported they were very good at doing almost half of the occupations in which they engaged and that their occupations were primarily either very meaningful or meaningful. While some methodological limitations were identified, time-geographic studies of community dwelling older people living independently are considered to have potential to contribute to community and social planning for older people as they can provide interesting insights to older persons' time use and occupational needs.

Health despite frailty: exploring influences on frail older adults' experiences of health

The aim of this study was to explore and identify influences on frail older adults' experience of health. A sample of older adults, 11 men and 11 women aged 67-92, with diverse ratings of self-perceived health ranging from poor to excellent were selected through a purposeful strategic sampling of frail older adults taken from a broader sample from a quantitative study on health. In total, 22 individual qualitative interviews were analyzed using qualitative content analysis in which themes were developed from raw data through a systematic reading, categorization of selected text, theme development and interpretation. To feel assured and capable was the main theme, which consisted of five subthemes: managing the unpredictable body, reinforcing a positive outlook, remaining in familiar surroundings, managing everyday life, and having a sense of belonging and connection to the whole. The importance of supporting frail older adults in subjective resilience in their context is emphasized.

Self-respect through ability to keep fear of frailty at a distance: successful ageing from the perspective of community-dwelling older people

With population ageing, there is an increased interest in how to promote a good old age. A predominant concept in these discussions is successful ageing, which is mainly based on researchers’ definitions. This article aims to explore successful ageing from the perspective of community-dwelling older people (24 persons aged 77–90 years). Individual open interviews were conducted and analysed according to qualitative content analysis. An overarching theme was formulated as “self-respect through ability to keep fear of frailty at a distance”. This embraced the content of four categories: “having sufficient bodily resources for security and opportunities”, “structures that promote security and opportunities”, “feeling valuable in relation to the outside world”, and “choosing gratitude instead of worries”. Ageing seems to be a dynamic process rather than a static structure and might therefore be susceptible to actions. Paying attention to attitudes and treating the older person with respect, particularly with regard to worries about increasing vulnerability, can lead to better ways of promoting successful ageing.

Negotiating the demands of active ageing: longitudinal findings from Germany

The challenges of population ageing and globalisation have been addressed by many welfare states in terms of active ageing policies, which in turn confront individuals with new demands such as keeping up to date with technological developments. The purpose of this paper is to analyse how individuals negotiate the demands of active ageing. The outcome variable was change in primary and secondary control strategies with regard to demands of active ageing over the course of one year. In a German sample of N = 602 men and women aged 55–75 years, we found a strong preference for engagement with these demands and a low preference for disengagement. Furthermore, a higher load of demands of active ageing was associated with an increase in engagement with these demands. However, when people perceived their everyday surroundings as unfavourable, their disengagement with demands of active ageing increased. Higher internal control beliefs concerning demands of active ageing were associated with an increase in engagement and a decrease in disengagement. We conclude that individuals strengthen their efforts to master demands of active ageing when they believe that they can control them. When the everyday ecology seems unfavourable, though, strategies are preferred that enable people to avoid a presumably lost case.

Active Ageing: An Empirical Approach to the WHO Model

Background. In the beginning of the 21st century, the world summit on population taking place in Madrid approved active ageing, WHO (2002) as the main objective of health and social policies for old people. Few studies have been done on the scientific validity of the construct. This study aims to validate the construct of active ageing and test empirically the WHO (2002) model of Active Ageing in a sample of community-dwelling seniors. Methods. 1322 old people living in the community were interviewed using an extensive assessment protocol to measure WHO's determinants of active ageing and performed an exploratory factor analysis followed by a confirmatory factor analyses. Results. We did not confirm the active ageing model, as most of the groups of determinants are either not independent or not significant. We got to a six-factor model (health, psychological component, cognitive performance, social relationships, biobehavioural component, and personality) explaining 54.6% of total variance. Conclusion. The present paper shows that there are objective as well as subjective variables contributing to active ageing and that psychological variables seem to give a very important contribute to the construct. The profile of active ageing is expected to vary between contexts and cultures and can be used to guide specific community and individually based interventions.

Managing the working body: active ageing and limits to the ‘flexible’ firm

Workforce ageing is considered in the context of four Australian employing organisations which are each in the process of change. In these organisations, perceptions regarding the relationship between the declining body and productivity led to a depreciation of the value of older workers and their consignment to less productive edges of organisations. While this was viewed as benefiting older workers, it was also acknowledged that workforce ageing will place severe constraints on the use of such practices, already regarded with suspicion by operational managers responsible for cost containment. Policies which aim to restrain biological and psychological decline, by supporting individual functional capacity and health, workplace design and ergonomics and developing the work community are advocated.

The Active Ageing-concept translated to the residential long-term care

PURPOSE

Active Ageing (AA), as described by the WHO (Active Ageing: a policy framework. World Health Organisation, Geneva 5), is an important concept in gerontology. Since the AA-concept has not been examined in the context of residential long-term care facilities, our study addresses this gap by describing the determinants of AA within this setting.

METHODS

A qualitative study with semi-structured focus groups, followed by a thematic analysis, was conducted. Through purposive sampling, four focus groups of either residents of long-term care facilities (n = 8), children of residents (n = 8), community-dwelling older people (n = 8) and gerontologists (n = 6) were formed.

RESULTS

The thematic analysis yielded nine determinants of AA. Seven correspond to those identified by the WHO: Culture, Behaviour, Psychological Factors, Physical Environment, Social Environment, Economic Characteristics and Health and Social Care. Two new determinants were identified: Meaningful Leisure and Participation. The determinant Participation is seen as crucial to AA in residential care.

CONCLUSION

This study points to a more extensive set of determinants of AA than those identified by the WHO (Active Ageing: a policy framework. World Health Organisation, Geneva 5). Staff of long-term care facilities can make use of these determinants to promote AA in their residents.

A brief questionnaire on metacognition: psychometric properties

OBJECTIVES

Existing questionnaires on personal views of one's own cognitive functioning are either unduly long, restrict their focus on memory, and/or capture complaints rather than the general status quo. A brief 9-item questionnaire was developed, assessing metacognition with two subscales covering metamemory and metaconcentration.

METHODS

The questionnaire was tested in a sample of healthy women (n = 228) aged 70-93 years, during two face-to-face interviews with an interval of 6 months.

RESULTS

Subscales were confirmed to have factorial validity. While objective cognitive test performance did not predict self-reported everyday functioning, metamemory and metaconcentration accounted for a substantial amount of its variance. The newly developed instrument was shown to be predominantly characterized by latent trait variance components.

CONCLUSION

The presented questionnaire is advantageous for the assessment of metacognition as it is brief and easily applicable. Since metacognition is highly relevant for sustained independence in old age, the questionnaire is suitable to capture important determining factors in research on aging phenomena and processes.

Perceived Level and Appraisal of the Growing Expectations for Active Ageing Among the Young-Old in Germany

Demographic change and the call for active ageing impose new demands on older individuals. Using data on German adults aged 56 to 75 ( N = 1,468), the authors investigated perceived level of activation demands (e.g., increased expectations that the young-old will contribute to the public good) and appraisal of them as threatening or challenging by individuals with different health status and socioeconomic backgrounds. Overall, perceived level of demands was moderately high, and they were seen rather as a challenge. East Germans, those with better subjective health, and those unemployed reported a higher level of activation demands, whereas retired and widowed individuals reported a lower level. Moreover, East Germans, individuals with lower educational attainment, and those reporting health problems (but not physically handicapped individuals) experienced these demands more as a threat and less as a challenge. The authors argue that more targeted policy strategies are needed to promote active ageing in disadvantaged groups.

Older people and 'active ageing': Subjective aspects of ageing actively

Following a critical overview of the active ageing concept, a thematic decomposition of 42 transcribed interviews with British people aged 72 years and over indicates that active ageing is understood in relation to physical, cognitive, psychological and social factors, but that these co-exist in complex combinations. The notion of activity in active ageing is grasped in relation to an active/passive distinction which emphasizes the enhancement or diminishment of concrete powers of activity. A 'challenge and response' framework is suggested for future research on active ageing.

Day-time sleep and active ageing in later life

The concept of ‘active ageing’ has received much attention through strategic policy frameworks such as that initiated by the World Health Organisation, and through government and non-governmental organisation initiatives. The primary goal of these initiatives is to encourage older people to be active and productive, and to enhance quality of life, health and wellbeing. It is well known that with increasing age, night-time sleep deteriorates, which has implications for how older people maintain activity levels, and leads to an increased propensity for day-time sleep. Using data from 62 interviews with people aged 65–95 years living in their own homes who reported poor sleep, this paper explores the meanings of day-time sleep, and how the attitudes and practices of ‘active ageing’ are intricately linked to the management of day-time sleep and bodily changes that arise from the ageing process. The desire to be active in later life led to primarily dichotomous attitudes to day-time sleep; older people either chose to accept sleeping in the day, or resisted it. Those who accepted day-time sleep did so because of recognition of decreasing energy in later life, and an acknowledgement that napping is beneficial in helping to maintain active lives. Those who resisted day-time sleep did so because time spent napping was regarded as being both unproductive and as a negative marker of the ageing process.

Social vulnerability, mental health and correlates of frailty in older outpatients living alone in the community in Italy

OBJECTIVE

To determine the main social, functional and clinical characteristics of community-dwelling older outpatients living alone and to find correlates of frailty in this population.

METHOD

Cross-sectional survey of 302 community-dwelling outpatients aged 65+ (median age 82 years) consecutively referred to a geriatric medicine clinic in Italy from June to November 2009. Participants underwent a comprehensive geriatric assessment including frailty status evaluated by means of the study of osteoporotic fractures (SOF) criteria. Student's t-test and the chi-squared test were used to compare subjects 'living alone' and 'not living alone' as well as 'frail' and 'not frail' subjects among the participants living alone. Multiple logistic regression analyses were performed to find independent correlates of frailty among participants living alone.

RESULTS

Participants 'living alone' were 124 (41%). Compared to subjects 'not living alone' (n = 178), they were older, received less assistance from informal and formal caregivers, had poorer living and financial conditions, a better cognitive status and functional self-sufficiency but a worse emotional status. One-third of them (n = 41) were frail. Among frail elders (n = 116), subjects living alone also showed a higher prevalence of unexpected new diagnoses of dementia than those not living alone. Independent correlates of frailty among participants living alone were: having experienced a severe acute disease in the past year (odds ratio [OR] 303.9; 95% confidence interval [CI] 13-7091; p < 0.001), dependence in the bathing BADL ability (OR 62.74; 95% CI 12.17-323.32; p < 0.001), depression (OR 10.43; 95% CI 2.31-47.13; p = 0.002) and incontinence (OR 3.98; 95% CI 1.01-15.66; p = 0.048).

CONCLUSION

In older outpatients living alone, including those who were frail, we found a lower availability of personal assistance, significantly more social and financial vulnerability and a higher risk of depression. In frail elders there was also a higher prevalence of underdiagnosed dementia. In order to better recognise frail subjects in this specific population, four independent correlates of frailty were identified.

Cross-cultural comparison between academic and lay views of healthy ageing: a literature review

The aim of this study is to specify the concept of ‘healthy ageing’ from both western and non-western cultural perspectives, and to compare the views of academics and lay older people. Thirty-four published peer-reviewed full papers in English and Chinese (traditional characters) were identified using electronic database searches. The key components of their definitions of healthy ageing were extracted and categorised into 12 domains. The results show that, in general, lay definitions (as described in 11 studies) included more domains (independency, family, adaptation, financial security, personal growth, and spirituality) and more diversity in the healthy ageing concept than academic views (which tend to focus more on physical and mental health and social functioning in later life). Certain domains were valued differently across cultures. As shown in previous studies, the findings affirm that healthy ageing is a multi-dimensional and complex concept and that there are substantial differences in different cultures. Moreover, we found that there are pronounced variations in the conceptualisation of healthy ageing as between academic and older lay people. Generally, older lay people perceive healthy ageing more broadly than the maintenance of physical, mental and social functioning. We suggest that academic researchers should integrate the more holistic perspectives of older lay people and cultural diversity into the classical ‘physical–mental–social’ healthy ageing concept.

Growing Older

This study explored experiences of eight rural, Anglo-Australian women aged between 65 and 75 using semi-structured interviews. Thematic analysis revealed three prominent themes: (a) the free and busy me highlights the increased freedom in later life enabling choices regarding activities the women would like to engage in; (b) the secret is being positive and pragmatic emphasizes the importance of adopting a pragmatic acceptance of growing older; and (c) narratives of growth and stagnation highlights the pursuit of growth among older women in order to enhance the current self. Findings emphasize the construction of later life as one of liberation, resilience and growth.

Quality of life in hospitalized seniors with psychiatric disorders (a cross-sectional study from the Kromeriz District, Czech Republic)

BACKGROUND

The quality of life is one of tools used for a comprehensive evaluation of provided health care services. Unlike medical specialties such as oncology or transplantation medicine where maintaining or improving the quality of life has been a traditional challenge, these issues are relatively new to gerontopsychiatric practice. The article is a contribution to research into the quality of life in hospitalized seniors with psychiatric disorders.

METHODS AND RESULTS

We designed a cross-sectional study involving 297 patients in two study groups from two main health care institutions in the Kromeriz District, the Psychiatric Hospital Kromeriz and St. Vincent de Paul Hospital. The WHOQOL-BREF questionnaire, MMSE, GDS, patient medical records, interviews and psychiatric assessment were used in the study. Generally, low ability to complete the questionnaires was observed in both studied groups and a low quality of life in hospitalized seniors was revealed, together with a high prevalence of underdiagnosed depression and dementia. Poor social contacts are also common in hospitalized seniors with psychiatric disorders.

CONCLUSION

Continuous evaluation of the quality of life in hospitalized seniors with psychiatric disorders and attempts at its improvement should become an integral part of health care provided to older people suffering from any psychiatric condition.

Day care centre attendance and quality of life in depressed older adults living in the community

Late-life depression is associated with disabled functioning and a poor quality of life (QOL). The aim of this cross-sectional study was to find out whether the attendance of a day care centre (DC) was associated with QOL in community-dwelling older adults suffering from a depressive disorder without dementia. The study enrolled 149 depressed older adults aged 70 or older, who consecutively underwent a comprehensive geriatric assessment from April to July 2008 at the Geriatric Medicine Unit of the Fondazione Ospedale Maggiore Policlinico in Milan, Italy. QOL was evaluated by means of the European Quality of Life Visual Analogue Scale (EuroQol VAS). DC attendance was quantified as number of days of attendance per week in the past month. Participants attending a DC at least once a week (n = 17) had a higher mean EuroQol VAS score than non-attendants (n = 132) (mean ± SD 58.8 ± 19 vs. 45.3 ± 22.5; P = 0.019). In multiple linear regression analysis a higher weekly attendance of DCs was related to a better quality of life according to the EuroQol VAS score (unstandardized coefficient 3.048, 95% CI 0.063-6.033, P = 0.045) after correction for age, sex, balance and gait abilities, comorbidity, pharmacotherapy, living alone, and severity of depression. Therefore, in older outpatients suffering from a depressive disorder without dementia the attendance of a DC was an independent correlate of the QOL. A randomized controlled longitudinal study will be necessary to determine whether attending a DC is really effective on the QOL in the management of late-life depression.

Reliability and Validity of the Health Enhancement Lifestyle Profile (HELP)

The Health Enhancement Lifestyle Profile (HELP) is a self-report measure for examining various aspects of health-related lifestyle in older adults through seven scales (Exercise; Diet; Work, Education, and Social Participation; Leisure; Activities of Daily Living; Psychological Wellness and Spiritual Participation; and Other Health Promotion and Risk Behaviors). The current study examined the reliability and validity of the HELP scales through classic test theory. The resultant alpha coefficients ranged from .75 to .92 among the scales, indicating acceptable to good internal consistency reliability. Construct validity was also supported by the interrelationships found among the HELP scales and the statistically significant correlations shown between HELP results and global health status (i.e., number of chronic conditions, self-related health). HELP scales can help occupational therapists identify and monitor health promotion occupations and risk behaviors and measure the outcome of services aimed at promoting healthy lifestyles in older adults.

Perceptions of active ageing in Britain: divergences between minority ethnic and whole population samples

OBJECTIVE

to identify perceptions of, and associations with, active ageing among ethnically diverse and homogeneous samples of older people in Britain.

DESIGN AND SETTING

cross-sectional and longitudinal surveys of older people living at home in Britain.

MEASURES

active ageing, health, psych-social, socio-economic circumstances, and indicators of quality of life.

RESULTS

respondents defined active ageing as having health, fitness, and exercise; psychological factors; social roles and activities; independence, neighbourhood and enablers. The ethnically diverse sample respondents were less likely to define active ageing as having physical health and fitness, and were less likely to rate themselves as ageing actively, than more homogeneous sample respondents. The lay-based measure of quality of life used was independently and consistently associated with self-rated active ageing in each sample

CONCLUSION

Policy models of active ageing were reflected in lay views, although the latter had a more multidimensional focus. Lay definitions of active ageing were also more dynamic, compared with definitions of quality of life and successful ageing. Differences in self-rated active ageing and perceptions of this concept by ethnic group need further exploration.